Less-Invasive Procedure Brings More Kidney Donations

From the WebMD Archives

April 11, 2000 (Lake Worth, Fla.) -- Kidney donation is one of the few ways a living person can give an organ to someone else for transplant, but it used to require a 10-inch incision and a six-week recovery time. A procedure called laparoscopic nephrectomy has made kidney donation easier, and a new study shows that once people find out about it, they are more eager to give.

Further, the study from the University of Maryland Medical Center shows that people who need transplants find it easier to ask friends or loved ones to sacrifice a kidney when it no longer means losing many weeks of work for recuperation.

In the new procedure, surgeons remove the kidney through a small incision. Not only is this method less painful than the traditional method, the hospital stay is usually two to four days (as compared to six), and the scar it leaves is only about two inches long. Patients are back to normal activity within two weeks, the study authors write.

"We believe that this less invasive approach will have a tremendous impact for thousands of people who need a kidney transplant. More than 44,000 people are on a waiting list nationwide, " researcher Steven Bartlett, MD, says in a statement describing the technique. "The waiting list grows by around 17% each year, and that is why living donors are so necessary.

Bartlett is professor of surgery at the University of Maryland School of Medicine and director of transplant surgery at the University of Maryland Medical Center, in Baltimore. Researchers at the medical center compared transplant rates before and after it began offering the laparoscopic technique, and found that the percentage of kidney patients who received a transplant from a living donor went from 12% to 25%.

Bartlett attributed the increase in donations not only to the new technique, but to a strong educational effort to inform potential donors and recipients about it

"The educational program and the less-invasive method of donating a kidney have more than doubled the chance that a patient with kidney failure today will receive a transplant from a friend or loved one, compared to just a few years ago," he says.

The surgeons also find that it is easier for patients to recruit donors with the laparoscopic technique. A third of the donors who underwent the new type of procedure were unrelated to the kidney recipients or were only distant relatives. Nearly four out of 10 donors traveled from out of state to donate.

The alternative to finding a living donor is to wait for a transplant from someone who has died.

"Living donor kidneys are better than cadaver kidneys because they last twice as long," says Johann Jonsson, MD, who reviewed the study for WebMD. The average cadaver kidney lasts six to eight years, he tells WebMD. Jonsson, director of the kidney transplant program at Inova Fairfax Hospital in Falls Church, Va., says doctors there are finding the same doubling of kidney donations as the University of Maryland.

"We're just at the beginning of the surge of either related or emotionally related donors, because the laparoscopy gives so many benefits we couldn't offer donors before," says Arieh Shalhav, MD, who also reviewed the study for WebMD. Shalhav is associate professor of urology at Indiana University School of Medicine, and a urologist at Methodist Hospital of Indiana in Indianapolis.

In the laparoscopic nephrectomy, surgeons make a 2 1/2-inch incision near the navel, along with four small holes through which instruments are inserted. The laparoscope, an instrument that houses a miniature camera that allows surgeons to see what they are doing on a video screen, is inserted through one of the holes. The surgical instruments are inserted through the others. The surgeons disconnect the kidney from the donor, wrap it in a plastic bag, and slide it out of the small incision. It is then transferred to the recipient.

Researchers also found that results of this laparoscopic surgery were slightly better than those of traditional surgery, with nearly 95% of the kidneys still functioning three years after they were implanted, compared to 91% with the traditional method.